Monday, 13 May 2013

On psychiatry, homeopathy, and the medicalisation of distress

I'm a damaged person; I know that. I know that that damage happened mainly in (and because of) my first six months of primary school. I know that because of that damage, I'm much more vulnerable to stress than most people are - or than I would be if I hadn't been sent to school. I'm now reasonably confident that I will carry this damage - this vulnerability - for the rest of my life, that I will never be free from the risk of another major breakdown, never free from little breakdowns such as the one I had last week.

In 1998, I broke my back for the first time. As I was driven in the ambulance to Ayr infirmary, I thought it was a foregone conclusion that I would be paralysed; in a wheelchair for the rest of my life. Suppose I had been right. Suppose I had had the spinal damage which would forever prevent me from walking again. Would you consider that an 'illness'? Would anyone?

The answer is clearly 'no'. There's no infectious agent. There's no underlying biological cause. It's damage. Something is broken. It can't be repaired. It's an injury.

My mental damage is not like a broken back. It doesn't permanently prevent me from doing anything. But it is like - it's very like - a shoulder that's been dislocated. A shoulder that's never been dislocated is pretty hard to dislocate: it's very strong. But once it has been dislocated, there's permanent damage to the soft tissue that binds it together. Most of the time the shoulder works well, moves smoothly and has the full range of movement it had before. But it's much weaker; if exposed to the wrong stress, it dislocates again. Again, this is not an 'illness'. There's no underlying biological cause. There's no infectious agent. Drugs may ameliorate the symptoms (pain, inflammation  swelling), but they won't cure the problem. There's damage - permanent damage. Something is broken. It's an injury.

For hundreds of years people with sincere good will, careful study and confident professionalism, have treated illness using homeopathy. We now know that this discipline is based on a mistaken model of the world: a model that denies the atomicity of matter, which assumes that no matter how much you dilute a solution, a proportion of the original solute remains. Because we know this, we know that despite the homeopathists' confident professionalism, their careful study and their sincere good will, the cures they prescribe are bogus. They can't work. And, because people in urgent need take their prescriptions in place of more scientifically grounded treatments, they actually cause harm.

For hundreds of years people with sincere good will, careful study and confident professionalism have tried to cure mental 'illness'. They have prescribed drugs. They have hunted for the infectious agents, the underlying biological causes. As David Kupfer, Chair of the American Psychiatric Association committee responsible for the new edition of the Diagnostic and Statistical Manual of Mental Disorders, writes 'we've been telling patients for several decades that we're waiting for biomarkers...'. That's what you do with disease. You find the infectious agent, or the underlying biological process of the illness, and then you find a chemical compound - a drug - which will interfere with that agent or process. But the problem is, they have been hunting for a Snark. As Kupfer goes on to say '...we're still waiting.'

It's an article of faith for Kupfer as for all psychiatrists that there must be some underlying biological cause, because if there weren't, mental illness wouldn't exist. So they cannot admit that their Snark actually is a Boojum. That their entire profession is based on category error, just like that of the homeopaths. It's sad for them. I feel their pain. But they must be stopped, because like the homeopaths they actually cause harm because people in urgent need take their prescriptions in place of more scientifically grounded treatments.

It's time to consign psychiatry, like astrology and homeopathy, to the dustbin of scientific history, where it can do no more harm.
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